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Latest Science: BP reduction provides benefits into old age

27 Aug 2021
Presented science not to be missed

The effects of pharmacological lowering of blood pressure (BP) on cardiovascular (CV) outcomes in older patients, particularly when BP is not substantially elevated, is uncertain.

As a part of the on-demand programme and simultaneously published in The Lancet, Professor Kazem Rahimi (University of Oxford, UK) presents results from a study investigating this issue, using an individual participant-level data meta-analysis of randomised controlled trials (RCTs) of BP-lowering treatment.

Data from 51 RCTs and 358,707 participants included in the meta-analysis were obtained from the Blood Pressure Lowering Treatment Triallists’ Collaboration and compared pharmacological BP-lowering treatment vs. placebo or other BP-lowering medications or compared more vs. less intensive strategies. Data were pooled and patients categorised into baseline age groups and BP categories (10 mmHg increments from <120 to >=170 mmHg for systolic BP and from <70 to >=110 mmHg for diastolic BP).

The age of participants at randomisation ranged from 21 to 105 years (median 65, interquartile range 59 to 75), with 42,960 (12%) participants aged <55 years, 128,437 (35.8%) aged 55 to 64 years, 128,506 (35.8%) aged 65 to 74 years, 54,016 (15.1%) aged 75–84 years, and 4,788 (1.3%) aged >=85 years.

Pharmacological BP reduction was found to be effective across age groups, with no evidence to suggest that relative risk reductions for prevention of major CV events varied by baseline systolic or diastolic BP levels, down to less than 120/70 mmHg. Although there was a suggestive evidence for diminishing relative risk reductions with increasing age (adjusted p for heterogeneity = 0.05) and limited statistical power in the oldest age group (90 years at the end of the study) in isolation, absolute risk reductions did not follow the same pattern and appeared to be even larger in the older age groups. Stratified effects on all-cause death followed a similar pattern, with no evidence to suggest that treatment increased mortality in any age group.

This most detailed study of the age- and BP-stratified effect of antihypertensive medication provides compelling evidence for the effectiveness of pharmacological BP reduction into old age irrespective of baseline systolic or diastolic BP. The authors concluded that antihypertensive medication should be considered an important treatment option, regardless of age, with removal of age-related thresholds from international guidelines.


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